PTSD and psychological trauma expert witness in Scotland
A report on psychological trauma turns on a small number of questions that are easy to state and harder to answer with rigour: whether the pursuer's presentation meets the ICD-11 criteria for post-traumatic stress disorder or complex PTSD, whether an adjustment disorder is the better fit, whether the index event was of a nature capable of causing that disorder, and whether the timing and content of the symptoms are consistent with the account given.
Instructions of this kind arise from road traffic collisions, assaults, workplace incidents, historical abuse claims and exposure to traumatic material in the course of employment. He is instructed by pursuer agents, defender agents and insurers, and the approach to diagnosis and causation does not vary according to who has instructed the report.
What Dr Qureshi can advise on
- Whether the presentation meets ICD-11 criteria for PTSD, for complex PTSD, or for adjustment disorder, and the basis for preferring one diagnosis over another.
- Whether the index event was of a kind and severity capable of causing the disorder found.
- Whether onset was immediate or delayed, and whether delayed onset is consistent with the diagnosis and the records.
- The relationship between the index event and any earlier trauma, including whether an earlier event has been reactivated rather than a new disorder caused.
- Prognosis with and without trauma-focused treatment such as EMDR or trauma-focused CBT.
- The treatment reasonably required, its likely duration and the basis on which it should be costed.
- Effect on sleep, concentration, relationships and capacity to work, including avoidance behaviour that restricts daily activity.
- Where relevant, the internal consistency of the account and its consistency with contemporaneous records.
Where the presentation raises questions of neuropsychological impairment following a head injury, or where the causative event is itself in dispute on the medical evidence, he says so and identifies the discipline better placed to assist.
Typical instructions
- Delayed-onset PTSD after a road traffic collision
- A pursuer whose symptoms did not appear until some months after a collision, having initially returned to driving. The instruction asks whether delayed onset is compatible with PTSD on the ICD-11 criteria and whether the collision remains the material cause of the current presentation.
- Complex PTSD with a history of earlier trauma
- A pursuer with a documented history of childhood adversity who presents after a further traumatic event in adulthood. The question is whether the current disorder is properly characterised as complex PTSD, and how much of the presentation is attributable to the index event as against pre-existing vulnerability.
- Workplace assault with an adjustment disorder in issue
- An employee assaulted by a colleague whose symptoms are significant but do not meet the full threshold for PTSD. The instruction asks whether adjustment disorder is the more accurate diagnosis, and what that means for prognosis and treatment.
- Joint instruction ahead of a proof
- Pursuer and defender agree a single joint expert on diagnosis and prognosis, with a fixed proof diet already assigned. Availability is confirmed before the instruction is accepted so the timetable set by the court can be met.
What the report includes
The report sets out the instructions received, the documents considered, background and personal history, a detailed account of the index event and its immediate aftermath, the course of symptoms since, mental state examination, and a reasoned opinion addressing each ICD-11 criterion in turn rather than asserting a diagnosis without showing the working behind it.
Where the account given at interview differs from the contemporaneous records — for example where GP notes record no psychological symptoms for some months after the event — that difference is stated explicitly, together with an assessment of whether it is consistent with a recognised pattern of delayed presentation or points against the diagnosis claimed.
The opinion closes with a statement of the treatment required, a reasoned prognosis with and without that treatment, and the statement of truth and declaration of independence required of expert evidence in the Scottish courts.
Related expertise
- Personal injury — Psychiatric injury reports for pursuers and defenders in Scottish personal injury actions.
- Anxiety and depression (including adjustment disorders and phobic anxiety) — Assessment of depressive and anxiety disorders arising from accident, assault or workplace events.
- Chronic pain and somatisation — Psychiatric opinion on chronic pain, somatic symptom disorder and medically unexplained symptoms.